Provider Demographics
NPI:1255448973
Name:IBERIA GENERAL HOSPITAL AND MEDICAL CENTER
Entity type:Organization
Organization Name:IBERIA GENERAL HOSPITAL AND MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:337-374-7104
Mailing Address - Street 1:PO BOX 10539
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-0539
Mailing Address - Country:US
Mailing Address - Phone:337-560-1992
Mailing Address - Fax:337-364-9102
Practice Address - Street 1:2205 OLD JEANERETTE RD
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-8687
Practice Address - Country:US
Practice Address - Phone:337-560-1992
Practice Address - Fax:337-364-9102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IBERIA GENERAL HOSPITAL AND MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA115207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LACN9239OtherMEDICARE RAILROAD GROUP
LA57477Medicare ID - Type Unspecified